老年人大面积急性心肌梗死心律失常防治

A study on the prevention and treatment of arrhythmias in the aged patients with large area acute myocardial infarction.

目的探讨老年人大面积急性心肌梗死（ＡＭＩ）并发心律失常的防治措施。方法将７６例老年大面积ＡＭＩ患者随机分为３组，Ａ组（３０例）及Ｂ组（２５例）每天静脉点滴２５％硫酸镁１０～１５ｍｌ和极化液，１２～１４天，Ａ组同时用利多卡因７２小时（首剂５０～１００ｍｇ静脉注射后按２～３ｍｇ／ｍｉｎ静脉点滴）；Ｃ组（２１例）静脉点滴极化液１２～１４天，并发室性心律失常患者加用利多卡因（用法同Ａ组）。结果心律失常发生率和严重心律失常发生率，Ａ组（３０．０％和１０．０％）及Ｂ组（２８．０％和１２．０％）均显著低于Ｃ组（７１．４％和４７．６％）（均为Ｐ＜０．０１），Ａ组与Ｂ组差异均无显著性（均为Ｐ＞０．０５）；室性心律失常控制有效率，Ａ组（８１．３％）及Ｃ组（８２．４％）均明显高于Ｂ组（２８．６％）（均为Ｐ＜０．０１），Ａ组与Ｃ组差异无显著性（Ｐ＞０．０５）；非室性心律失常控制有效率，Ａ组（８１．８％）及Ｂ组（７７．８％）均显著高于Ｃ组（１８．２％）（均为Ｐ＜０．０１），Ａ组与Ｂ组差异无显著性（Ｐ＞０．０５）；心律失常患者病死率，各组差异均无显著性（均为Ｐ＞０．０５）。结论提示老年人大面积ＡＭＩ时可早期使用硫酸镁防治心律失常，利多?

Objective To study the prophylactico therapeutic measures for large area acute myocardial infarction (AMI) complicating arrhythmias in aged patients. Methods Seventy six cases of patients were divided into three groups at random. Group A(30 cases ) and group B(25 cases) were treated with 25% magnesium sulfate (iv drip, 10 15ml every day) and polarized liquid for 12 14 days, and in group A, lidocaine was used for 72 hours (initial dose 50 100mg iv, then 2 3 mg per minute, iv drip), Group C(21 cases) was treated with polarized liquid for 12 14 days and lidocaine was added as in group A when complicating ventricular arrhythmias. Results The incidences of arrhythmias and serious arrhythmias in group A (30 0%,10 0%) and group B(28 0%,12 0%) were significantly lower than that in group C (71 4%,47 6%),(all P <0 01),but no obvious difference between the group A and group B(both P >0 05); The effective rates of control of ventricular arrhythmias in group A(81 3%) and group C (82 4%) were obviously higher than that in group B (28 6%), (both P <0 01), and no significant difference between group A and group C( P >0 05); The effective rate of control of non ventricular arrhythmias in group A (81 8%) and group B(77 8%) were significantly higher than that in group C(18 2%) (both P <0 01), and no obvious difference between the group A and group B ( P >0 05); the death rate of arrhythmias was not different in the three groups (all P <0 01). Conclusions In aged patients with large area AMI magnesium sulfate may be used for preventing and treating arrhythmias in the early stage and lidocaine is useful in the treatment of ventricular arrhythmias, but not in prophylaxis.